Speech therapy with a twist!

The Bagless SLP – Part 2: The Good, the Bad, & the Unexpected

March 24, 2015

Welcome back! Or, if you’re just joining in on this series, head over to Part 1 to see what this Bagless SLP series is all about! In the last post, “This Isn’t Mary Poppins’ Bag”, I let the cat out of the therapy bag that I was going (gasp) BAGLESS! The response has been great and I have loved hearing from fellow SLPs and Early Intervention SLPs about their experiences with “the bag”. It has been about a month since I left the bag behind, cleaned out my trunk, and started venturing into homes with only a few or ZERO therapy items. I wanted to come back and write about how it’s been going… the good, the bad, and the unexpected!

First, a confession… going bagless scared the bubbles out of me! I was terrified of irate parents, inattentive toddlers, and stagnant therapy sessions and progress. I was almost so scared that I stuck to what I had known… the bag. It was my security blanket. It allowed me to control therapy, look like a magic speech wizard, and feel comfortable entering the unknown of a family’s home. But, I did it anyway. I did it because I believe that research and the results that it garners are an important part of our job. We are to learn from research and utilize it in our therapeutic approach when appropriate. Even ASHA’s Scope of Practice states that “an important characteristic of the practice of speech-language pathology is that, to the extent possible, clinical decisions are based on best available evidence. ASHA has defined evidence-based practice in speech-language pathology as an approach in which current, high-quality researchevidence is integrated with practitioner expertise and the individual’s preferences and values into the process of clinical decision making (ASHA, 2005).” So, I did it… I went bagless!

The Good

Let’s talk about the good stuff first… the bits that have made me absolutely positive that bagless is the best thing EVER!

Can we talk about how awesome it is to have a trunk again? I’m not sure if you remember but my trunk used to be filled to the brim with some incredible therapy toys! And then I took nearly everything out! And it has been incredible!

I bet you’ve had those parents that leave the room or sit far away during sessions when you’re baggin’ it, right? Well, when you go bagless that really decreases. I discussed why I was going to be bringing fewer/no materials with me with my families before cutting the cord. And now… many of my families are WAY more involved than they were previously.

Planning time has decreased! I definitely still know what I want to be targeting with the families and we discuss it more now that I don’t carry a bag. I plan with the families for the next session at the end of the current session. I might say things like, “You talked about wanting to try adding language to his meal times. Could we try doing a small snack next week during our session?”. We take a few minutes to talk about what we will be attempting at the next session if it’s anything outside of play.

And finally, one hyphenated word: Carry-over. People swore up and down that carry-over would increase. But, I knew my families and I knew that those who would carry-over activities already were. I think of everything that I was told, I believed the carry-over hype the least. I’m happy to report that I was very wrong. Do all of my families follow through with activities and techniques throughout the week… nope. But more of them do now than when I toted around that bag. Getting to know and beginning to use their family routines and materials has been huge for several of my families. It’s so great to hear about what a family was able to do between sessions. And, do you realize that it means that the child did not have 1 hour of therapy each week… they had MORE?!?

The Bad

I hesitate to use the word “bad”. I think that maybe “less-than-desirable” would be more appropriate… until I realize that it was bad. And that’s okay. Here’s the bad bits of going bagless… no-holds-barred!

Some things never change. Yes, the majority of my parents have become more involved in sessions after I decreased the amount I was bringing into homes. However, I have a few parents that want nothing to do with sessions. I invite and invite and invite… it doesn’t happen. I’m lucky when some of them even observe the session. It’s the not-so-pretty side of EI… And going bagless hasn’t been a magic bean for getting ALL parents on the floor and working alongside me with their child.

The “why” questions have been there. I’ve re-explained to some parents several times why using their materials and routines will be better for their child. Some still believe that my bag did, in fact, belong to the magical Mary Speechins. Like many other aspects of EI, going bagless will require you to educate parents/families. So, you’ll want to know your stuff… I listed some great resources in my Part 1 post!

The comparison to Developmental Therapists: I think one of the major problems that I’ve run into with buy-in has been from families that also receive DT. The majority of DTs in the Chicago area bring enormous bags into sessions (I thought mine was big…) filled to the brim with every toddler goodie you could imagine. The crazy part is that they do this even when the family has OODLES of age-appropriate toys… even using their own toy when the family has the exact same one on the shelf behind them. Parents see this and then see me and it doesn’t compute. I’m not here to fix DT therapy provision… I do question it but I can’t fix it. What I can do is explain that they target play and concepts and occasionally language… but I target communication. And they don’t make a toy for communication… they make people for that.

Feeling inept: Yep, I’ve left sessions swearing under my breath. (wait, SLPs swear?!?) Some sessions flabbergast me and I know that it would have been 100X easier to have done that session with my blankie bag! I have to get into my car, blast some music, and remind myself that it may not have been a picture-perfect session but it was real. And I’ve learned more about my families, clients, and how to adjust future sessions.

The Unexpected

I like to think that not much surprises me. I’ve worked in the field for a while and have seen many of the incredibly surprising scenarios that are out there. However, going bagless has surprised me. There have been so many unexpected moments. Here are some of the most unexpected!

I have parents leading therapy with their child… what?!? I’ve always tried to have my parents assist but have held on to the lead position more than I should have. The first few sessions were a bit rough but after parents started to get their feet wet… they took ownership! I model or talk about a technique, we try it together, and BAM! Many of my parents don’t require more than that and some additional feedback throughout the activity. It really blew me away! And I love it!

Taking therapy outside has been incredible! It’s still been a little chilly in Chicago (6″ of snow yesterday) but we’ve done a few walks so far. I’m so excited to see what it looks like when we are really able to get out into the splendid summer weather in Chicago. You can do bagless therapy anywhere! Since you are wanting parents to carry-over techniques throughout the day, you really should be able to be with the family anywhere and doing therapy. It sounds crazy but I’m not ruling anything out. Restaurant, Target, park, bathroom, yard, living room… I’ll go bagless anywhere!

Routines are a great way to target communication. I’ve had breakfast with clients, talked about language during a poopy diaper change, and emptied a cabinet of every plastic box and lid the family had. These are things that families do each day and I wasn’t taking advantage of them. They are lost minutes of intervention if you aren’t showing families how they can be language rich activities. Get creative and get involved in routines!

EmPOWERment is POWERful! Families are naturally hesitant to believe that they could be the one to make a change in their child’s communication. I’ve made it a personal goal to be very empowering for my families. I compliment them when I see them using a technique, celebrate goal progress, and have tried to become more of a coach and partner for them. It has really enhanced the relationship that I have with several of my families and I can’t wait to see how it continues to do so.

Going bagless has been terrifying and terrific. I definitely feel like it’s in the best interest of my clients. However, it hasn’t been perfect and my version of bagless therapy isn’t perfect either. So, I will address imperfection in Part 3!

I’d love to hear more about your experience with bagless therapy below. Or any resources that I haven’t included in Part 1 that you feel are important!

Lovely comments

I just read parts one and two of this post after seeing it in a Facebook EI thread. I’m still in graduate school, but I found both parts to be so captivating that I incessantly clicked on the icon for Part 3 to no avail before realizing this is super current and it’s not posted yet! Can’t wait for the next installment. Inspirational!

“What I can do is explain that they target play and concepts and occasionally language… but I target communication. And they don’t make a toy for communication… they make people for that.”

I love this statement! It’s so true. I’ve been doing a few home sessions “bagless” for families in a Hanen program. It’s been so freeing to walk into a home with just a few pieces of paper to take notes. The families have gained so much more from the sessions and I’ve felt so much more useful.

I love that quote too, Meghan! What a great way to communicate the difference. I’ve been going in with a couple toys or completely “bagless” for all of my new clients. For the past 10 years, I have plopped down on the floor and immediately enticed my clients with the magical toy bag. If I bring it now, I hide it a bit and only open it if the situation calls for it, which doesn’t come up much! Our agency issues all clinicians a company branded toy bag to tote around. Knowing that other therapists are bringing this to homes, I now bring a different looking tote that the kids don’t already associate with toys.

Danielle, any chance you can give a quick run down of what you have left in your trunk? (By the way, I’m drooling over all that free space!)

I love this series. I was in EI outside Chicago for several years so I know all about toy bag dependence. I’m getting ready to go back to doing EI full time in Kansas and it’s going to be great to get to start fresh with families. I can’t wait for part 3!

After a compelling class at this year’s CSHA conference where “bagless” came up, it made so much sense to me. Still took a month or 2 to let go, to change, and now after getting excited and experiencing a couple weeks without my usual “way” I got cold feet this week and have gradually eased in more and more materials into my car and into my arms. I am so glad to come across your blog here. I needed the boost of encouragement. It really does make so much sense. Thank you so much for sharing your experience.

I was so happy to find this post. I am starting an EI job in addition to full time my school-based job. I have been eagerly buying toys so that I feel prepared and have lots of options for therapy. Your post(s) have had me thinking twice about bringing ten different toys into the home when I can use what the family has. I went to an EI workshop last year that encouraged us to use recycled materials for therapy, because most homes will have an empty container or egg carton that can be easily turned into a toy that targets multiple words, concepts, etc. Thanks for this post! It is definitely being bookmarked on my browser!

Reading your blog for a credentialing activity in Indiana…one year after your posts. I go bagless about 50% of the time. I have specific reasons for my bag: I teach routines for getting access to “the toys” which consist of materials that most families have access to: bubbles, balloons, some books, old fashioned toys such as spinning tops and so on. Absolutely no battery operated toys! I also ask parents to sit down with me on the floor (and explain why). Parents are requested to join in with the chants, gestures, signs etc. The only parents that are allowed to opt out are the physically disables or elderly (grandparents taking care of their grandchildren or great-grandchildren)…I use the recurring toys as a way to measure growth in new vocabulary (as well as parental report on a regular basis), child’s initiation of requests for toys (they do not have access to anything without a communication request) and even then…I do warn parents that I won’t always bring the bag in because it is about them, the interaction, and the time in between the sessions that is important. I educate parents as much as possible during my sessions and we talk about their new, old, ongoing concerns every week. Thank you for your blog, it has been very informative and I hope to join the facebook group! So, now, off to find and read #3…

Hi Larissa, thank you for letting me know that this was how that bit could be perceived, although it was not my intention. I was expressing that where I was practicing at the time of this article, a major struggle for me in going bagless was that my parents couldn’t initially understand why the DTs in that area brought items into the environment and I was now implementing treatment strategies within their routine instead. I’m not here to state that all DTs use outside materials or that, for their particular goals, it may be appropriate. I was just stating that it made my transition to bagless a little more tricky and that I had to explain the “why” and “how come” to some parents on multiple occasions. I hope this clarifies my statement. DTs are great members of the team and children benefit from services with skilled DTs on their team!